A Growing Crisis in Mental Health Among the Nation’s Elderly?

As medical director of Psychiatric Emergency Services at Queen’s Medical Center in Honolulu, Hawaii, Brett Lu, MD, has observed an upsurge in exhausted caregivers dropping off elderly individuals at a hospital’s emergency department, a rise in the numbers of elderly homeless persons being reported for socially inappropriate behavior, and a two-fold increase in 911 calls concerning elderly relatives with dementia who are attacking family members and caregivers.

These scenarios may portend a mental health crisis facing the nation’s aging population, Lu said during a press conference at the American Psychiatric Association’s annual meeting.

To gather objective evidence that might demonstrate whether there is increased use, reliance, and burden on psychiatric emergency services for elderly populations, Lu and others initiated a study. They examined the length of stay and age of patients triaged to the psychiatry section of the medical center’s ED from 2007 to the present. Queen’s Medical Center is the largest hospital provider in Hawaii and has the only ED staffed by psychiatrists 24/7, Lu said.

Of the 14,402 patients included in the study, 787 were 65 years of age or older. Using a year-by-year analysis, the researchers found that the percentage of psychiatric ED visits by adults 65 years and older is increasing. The largest increase (30%) occurred between 2008 and 2009.

The length of stay is also longer for patients 65 years and older (a median of 403 minutes versus 357 minutes for younger patients).

“Elderly patients with psychiatric symptoms are an underserved, disadvantaged, and dispossessed population in the United States,” said Lu, who is also director of the center’s Community Geriatric Psychiatry Department. Lu pointed to shortages in community resources required to effect a safe disposition plan and a shortage of providers specializing in geriatric care. Additionally, he said, poor Medicare reimbursements provide a disincentive for psychiatrists to accept new geriatric patients.

An assistant professor of psychiatry at the University of Hawaii at Manoa, Lu warned that what is happening in Hawaii will likely occur across the nation.

“In the United States, people are living longer. . . life expectancy is approaching 80 years. Together with the Baby Boomers, the population of those 65 years and older is expected to double to 70 million by 2030. We are talking about 20% of US population at that time,” he said. “More alarming is that dementia will develop in 30% of this elderly population by age 85; a majority will experience acute psychiatric symptoms, such as paranoia, hallucinations, and wandering. So there is bound to be a disproportionate increase in requests for psychiatric services.”

There needs to be policy changes at all levels to cope with the mental health crisis facing the nation’s elderly, Lu said. Approaches in Hawaii include hospital-academic partnerships to address the growing needs, and implementation of telepsychiatry programs.